• Cathelijne M van Zelst, Matthijs L Janssen, Nadine Pouw, Erwin Birnie, Castro Cabezas Manuel M Department of Internal Medicine, Franciscus Gasthuis en Vlietland, Rotterdam, Zuid-Holland, The Netherlands., and Gert-Jan Braunstahl.
• Pulmonology, Franciscus Gasthuis en Vlietland, Rotterdam, Zuid-Holland, The Netherlands c.vanzelst@erasmusmc.nl.
• BMJ Open Respir Res. 2020 Dec 1; 7 (1).

BackgroundSeveral characteristics of the metabolic syndrome, such as obesity and hypertension, have emerged as risk factors for a poor clinical outcome in COVID-19. However, most reports lack data on the metabolic syndrome itself. This study investigated prospectively the relationship between respiratory deterioration and the presence of metabolic syndrome or abdominal adiposity in patients with COVID-19.MethodsA prospective observational cohort study analysing patients with respiratory symptoms who presented at a local emergency department in the Netherlands. The influence of abdominal adiposity-assessed by an increased waist-hip ratio-and metabolic syndrome on respiratory deterioration and the length of hospital stay were analysed with multivariable logistic regressions and Kaplan-Meier analyses.ResultsIn total, 166 patients were analysed, of whom 86 (52%) tested positive for COVID-19. The prevalence of metabolic syndrome did not differ between patients with COVID-19 with and without the need for intubation or level of supportive care (37.5% vs 48.4%, p=0.338). In contrast, abdominal adiposity is an independent risk factor for respiratory distress in COVID-19, adjusted for metabolic syndrome, age, gender and BMI (OR 1.11, 95% CI 1.02 to 1.20, p=0.014).ConclusionThis study shows that abdominal adiposity, and not the presence of metabolic syndrome, is associated with clinical deterioration in COVID-19. This prospective study provides further insight into the risk stratification of patients with COVID-19 based on a simple measurement as the waist and hip circumference.Trial Registration NumberNL8580.© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.

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